Relapse Prevention

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What Is A Relapse Prevention Plan And Early Warning Signs?

Relapse refers to a 'recurrence of symptoms of a disease after going through a period of improvement. '

After some time going through e.g. substance addiction treatment, a relapse is when you go back to the intake of the substance. It is a setback to sobriety, and generally happens in a series of steps.

Relapse Process: The Stages

There are three distinct stages of relapse, which happen progressively over time. These are the early warning signs of relapse, that must be identified in order to help in preventing relapse. However, when not identified, relapse is inevitable.

A relapse prevention plan is necessary when you see the following early warning signs.

Emotional Relapse

Emotional relapse, as the name suggests starts emotionally, which means that the person will start thinking about using drugs or alcohol in this stage. Now, if these are not identified as the early warning signs, the person may go back to substance abuse.

The main emotional relapse early warning signs are;

  • Extreme mood swings
  • Wanting to isolate yourself.
  • Poor sleeping habits..
  • Not eating a healthy diet or poor eating.
  • Poor self care
  • Mental urges.
  • Negative emotions.
  • Feeling uncomfortable in own skin.
  • When you feel uncomfortable
  • You feel overwhelmed
  • You feel exhausted.
  • Not going to meetings
  • Going to meetings but not participating
  • Holding in one’s thoughts and feelings
  • Avoiding one’s own problems
  • Not engaging in sober fun

It is important for the individual to identify these as the common triggers to relapse, and must find coping skills for relapse prevention.

Emotional relapse is the first stage to relapse, and one thing that can help during this stage is journaling.

Once you realize that a vicious cycle is about to start, and your mental relapse is at risk, then you should come up with a plan for self care so you can avoid succumbing to relapse.

It is extremely essential that emotional relapse is prevented by all means. Find healthy coping skills for your feelings so you can change your behavior of substance abuse once and for all.

Mental Relapse

Mental relapse is the second stage after emotional relapse. If the first stage(emotional relapse) does not change your behavior, then you will fall into this very dangerous and greater risk stage. At this stage, you must be extremely careful in your everyday life so you can prevent relapse.

It will require you to practice self care, understand relapse prevention and learn how to overcome anxiety as this comes with a lot of important coping skills for maintaining sobriety.

During this stage, you will be fighting with yourself on whether or not you should return to drug abuse, or not. It is almost a mental illness, and support groups are needed to get you through this.

The common signs of early stages of mental relapse are;

  • Experiencing serious cravings
  • Extreme anxiety disorders
  • Severe mental health issues
  • Poor sleep
  • Health problems
  • Fantasizing about using
  • Feeling overwhelmed
  • Bargaining times it would be “okay” to use
  • Planning physical relapse
  • Glamorizing drug or alcohol use
  • Minimizing the consequences of using
  • Thinking they can control substance abuse

This is one of the most difficult stages of relapse, and the person is at higher risk of physical activity of relapsing.

Experienced addition from past use will tell you that you can handle mental relapse but substance abuse is an extremely complicated process, and relapsing may come with some fatal consequences.

Relapse prevention during the states of relapse are most ideal. In order to avoid relapse, and a whole new set of addiction issues, you should consider the following;

  • Coming up with a relapse treatment plan
  • Talking to a trusted peer
  • You should enter treatment again.
  • Wait for 30 minute when going through serious craving
  • Taking sobriety and recovery information again, one step at a time.
  • Use relaxation techniques.
  • Understand that this is a gradual process
  • Practice self care
  • Exercise a healthy lifestyle.
  • Try to remember the negative consequences of addiction.
  • Practice what you learnt during addiction treatment.

If you do not deal with mental relapse and your mental health, then this could potentially lead to a full on relapse.

Physical Relapse

After mental relapse, the last of the three stages of relapse and the most difficult stage is the physical relapse.

It is also the third and final stage.

This involves the active use of drugs or alcohol. It is the worst of the stages of relapse as it means that the treatment did not work, and the individual who has experienced addiction is back to taking drugs.

Failing to control the mental relapse and getting to this stage doesn't necessarily mean that you have failed, the individual simply needs to re-evaluate their mental health and practice more self care.

At this point of drug use, recovery begins again. A Guide for Relapse Prevention : Independence Press, 1986 (1) can help you understand how to prevent relapse.

Warning Signs of Relapse

While each of the stages of relapse comes with its own warning signs, there are usually general warning signs of relapse that one should look out for. This is because they can help someone struggling to clearly identify that they are in danger even before they get to the first stage of relapse.

The general signs of relapse include;

  • Health problems as a result of post acute withdrawal.
  • A false sense of control over the substance abuse.
  • When one hangs around people and places they associated with substance use.
  • When there's a sudden change in behavior
  • Isolation and mental illness.
  • Not engaging in fun activities.
  • Doubting one's treatment and recovery process
  • Feeling extremely stressed after treatment.
  • Experiencing depression.
  • Reminiscing about past use.

Abbeycare Relapse Treatment and Prevention

Relapse Prevention is arguably one of the most important components of drug and alcohol rehab within Abbeycare treatment center and the maintenance of recovery.

Addiction is known as a chronic relapsing condition.

Bearing that in mind and due to the dangers attached to alcohol and drug use, Relapse Prevention techniques and strategies can protect the substance user from the catastrophic effects of re-dependence.

A return to problematic substance use can be counteracted with the appropriate care, attention, expertise and infrastructure in place. To support, encourage, educate and change the behaviours attached to using substances hazardous to health and lifestyle.

We are also on standby for post acute withdrawal symptoms that can cause mental illness and relapse.

Common Triggers of Substance Abuse Relapse

Other than warning signs, there are some triggers that can cause one to relapse. These triggers, when identified will help prevent physical relapse.

  • Post acute withdrawal symptoms (anxiety, nausea, physical weakness)
  • Post acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep)
  • Poor self care (stress management, eating, sleeping)
  • People (old using friends)
  • Places (where you used or where you used to buy drugs)
  • Things (that were part of your using, or that remind you of using)
  • Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired)
  • Relationships and sex (can be stressful if anything goes wrong)
  • Isolation (gives you too much time to be with your own thoughts)
  • Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you)
  • Mental health disorders

Reaching Out

Relapse can actually be prevented when its caught early. Anyone can help bring a loved one out of this dark hole of addiction.

Most people will feel ashamed that they have resorted to their old ways, and may not be willing to ask for help. This, coupled with mental health issues and poor self care will inevitably lead to relapse.

The best thing to do is reach out to such a person and become their sponsor. This means you become their sober friend and help them with some self care tips, including enabling them see reason, and why they should not abuse drugs any more.

This process should also involve re-enrolling the individual to a rehab and mental health facility so they can go through the recovery process once again. Learning and understanding the three main stages of relapse will help you identify instantly when someone is about to suffer relapse.

Is Relapse Failure?

No. relapse is not failure. As a sober companion, you must ensure that your loved one or family member understands that relapse is not failure, and give them some points on how they can go through rehab treatment once again.

Unfortunately, relapse is a very common part of recovery and most people who are healing from addiction will go through it.

The best thing would be to learn from the above three stages -  the main warning signs and be on the look out at all times.

Now, while its common, it doesn't mean that everyone must go through physical relapse. Learning about the warning signs will help prevent this. It will also ensure that you do not disrupt your sobriety.

At Abbeycare treatment clinic, we understand that relapse can occur and are prepared for it. Our addiction treatment is well designed to include aftercare for a number of years, through our outpatient clinic in order to help prevent the occurrence of relapse.

Call us today and start your sobriety success journey with us.

Relapse Prevention At Abbeycare

Abbeycare is a residential rehab clinic, and the intention of rehab within Abbeycare is to support programme participants on becoming alcohol/drug free, arm them with the tools to sustain ‘normal living’ and ensure relapse does not occur.

Every area of the rehab facility has been organized and designed to cater for all of the above and happens within three areas.

  • Detox
  • Rehab
  • Aftercare

Each area has been specifically designed to combat relapse. The Detox is prescribed to patients on an individual person-centred basis after a further and comprehensive medical report and assessment has been undertaken.

Detoxification is the safe process of eliminating harmful substances from your body. (1) These substances are then allowed to flush away from your body.

Detox from drugs and alcohol should be done under medical supervision, as the process is likely to cause some severe withdrawal symptoms, as a result of the chemicals leaving your body. These symptoms can be life threatening, and you will need a professional to help you through the process.

The Detox will be delivered on a daily basis and tapered off gradually and will normally last 7-14 days. The prescription is written by the specialist medical doctor to ensure the patient is comfortable as alcohol or drugs are withdrawn.

The correct prescription and support of the team within Abbeycare during this time encourages the patient to keep on going until they reach the end of their detox. Hopeful for a future without the need or use of alcohol and drugs.

The Rehab phase at Abbeycare is the main component for change to occur within a programme participant. Change is vital for ongoing recovery to occur Post Rehab.

The team of Psychotherapists clients will work with are trained in many counselling skills created to promote a change of thinking and behaviour around the purchasing and consuming of alcohol or drugs.

Prior to rehab the belief may be that substances are required to be taken in order to perform normal daily functioning or not to become unwell. Once these substances have been removed this faulty thinking will be addressed.

The client will no longer believe they need alcohol or drugs to survive and will hopefully have identified with therapist support their need for change.

Many forms of therapy will be delivered to ensure the relationship with drugs and alcohol is challenged, denial has been changed to acceptance and the desire to continue using alcohol or drugs Post Rehab has been removed.

Without detox and rehab, aftercare would not exist. Aftercare has been created with the soul intention of supporting long-term recovery and ceasing the use post rehab.

Aftercare is supportive, inclusive, empowering and promotive of long-term sobriety.

Participants in the aftercare programme can make strong connections with others and build lasting and meaningful relationships.

In modern times ‘stress’ can be a huge motivator to relapse. One of the many benefits of aftercare is a safe place to talk with like-minded people. Talking through stresses instead of acting on them has been shown to reduce relapse.

Another benefit to aftercare is the supportive nature of the group, if relapse occurs, a quick return to aftercare may stop a long-term relapse from occurring.

Also, the aftercare facilitator has been trained to detect a relapse by one of their clients prior to relapse by analysis of their body language, conversation or actions.

Clients can attend aftercare at Abbeycare for up to 18 months post rehab and has been shown to reduce rates of relapse exponentially.

The three components of treatment within Abbeycare have been devised to preventing relapse.

Therapy

Therapy in rehab is focused on probing deeper into motivations causing addiction to prescription medicines. These deeper reasons may emerge during treatment and are likely to cause emotional reactions. Hence, guidance from addiction specialists may be valuable in order to cope with the stress of changing a lifestyle pattern.

Relapse Prevention Techniques at Abbeycare

These techniques if followed have been shown to decrease relapse rates. In some instances, attendance at rehab may be a once in a lifetime experience and participants are encouraged to use their time productively.

A common saying in rehab is ‘you get out what you put in.’

Apathy in not conducive with a therapeutic environment designed to elicit positive and life changing results. Let’s consider some techniques to implement in rehab at Abbeycare:

  • Practice the principle of self-honesty
  • Communicate feelings, emotions, thoughts
  • Promptly discussing thoughts of using alcohol or drugs with therapist
  • Attend Cognitive Behavioural Therapy (CBT) sessions
  • Take part in Motivational Enhancement Therapy (MET) with therapist
  • Apply the principles of Step 1 from the 12 Steps i.e. abstinence
  • Discover the ongoing benefits of Holistic Therapies

Relapse Prevention – Self Honesty

It could be argued relapse begins long before the physical act of using alcohol or drugs. Asking the following questions to self can be helpful:

  • Do I really want to stop or am I stopping to please another?
  • What am I prepared to do to stay stopped?
  • What areas of my life do I need to change?
  • Am I willing to accept the help on offer?
  • Am I willing to create an Aftercare plan and follow it Post-Rehab?

If the participant is not stopping the use of alcohol or drugs because they want to then relapse in most cases is almost inevitable. However, it must be noted many have attended rehab for the wrong reasons i.e. to please another but stayed for the right.

If the participant is only prepared to follow certain suggestions on offer within Rehab by the specialist therapy team then the ambivalence to change certain aspects of life may also result in relapse.

The creation of an Aftercare Plan within Abbeycare with the allocated Case Manager. (Case Managers are allocated on arrival at rehab). Is a vital component and deterrent to relapse. Aftercare if followed promotes long-term recovery.

If the answer to all the questions is honest and positive i.e. I want to stop for myself and I am prepared to take all the suggestions on board and implement them into my life then the incidence of relapse will reduce.

Relapse Triggers or Red Flags

Acting in ways that are not conducive to long-term recovery have been shown to increase the risk of relapse below is a list of warning signs.

  • Isolation
  • Not asking for help
  • Anxiety
  • Stress
  • H.A.L.T Hungry Angry Lonely Tired
  • Spending time with old companions in the use of alcohol or drugs
  • Overwhelming feelings and emotions
  • Complacency
  • Pride
  • Relationships – platonic and sexual
  • Ill health
  • Withdrawals
  • Dishonesty

Recommendations To Stay Substance Free In The Community

The following is a list of recommendations. If followed the rate of relapse is significantly reduced for the client. These recommendations are vital for maintaining the recovery gained in rehab upon leaving and returning to home.

  • Stop socialising in pubs and clubs or drinking establishments early recovery
  • Cut ties with other drug users
  • Try not to keep secrets from your therapist or recovery sponsor
  • Take guidance when making life changing decisions – relationships, jobs, housing etc.
  • Share any thoughts of using alcohol or drugs as soon as they arise with therapist or recovery sponsor

Relapse Prevention Strategies - Post Rehab

After leaving rehab there are many strategies the client can implement to stay sober.

  • Think of your worst day – in this instance if thoughts of using alcohol or drugs return the client can think of their worst day in active addiction. This can act as a powerful deterrent.
  • Tell someone – sharing thoughts of using will reduce the obsessive thinking and talking to someone will help put things into perspective
  • Distract yourself – reading a book, exercise or going for a walk can all act as distraction techniques until the thought subsides.
  • Live in the day – looking too far into the future can create anxiety and fear those in recovery are encouraged to keep the focus on one day at a time
  • Relaxation techniques – yoga, meditation, mindfulness can all reduce any thoughts of alcohol or drugs and calm the mind.
  • Aftercare – attending aftercare for up to 18 months post rehab has been shown to reduce the incidence or relapse
  • Peers – talking to people who know how you feel will give the client identification and motivation to carry on
  • Sponsor- call a recovery sponsor to share the day or any problems
  • Writing – if unable to access recovery meetings or share with another writing down feelings can lift the spirits
  • Reading literature – there are many recovery books such as The Big Book of Alcoholics Anonymous for those in recovery to read
  • Listening to recovery shares – the three main fellowships currently have recovery shares online listening to these can renew purpose for life
  • Implement Cognitive Behavioural Therapy – the therapist within Abbeycare will show their clients techniques to self-implement within the home
  • Implement Motivational Enhancement Therapy – the therapist within Abbeycare will show clients techniques to follow once home
  • Practice 12 steps – the 12 Steps are a tried and tested model of recovery after working with a recovery sponsor they can be used in daily life to help maintain long-term recovery
  • Delete old phone numbers – if there are phone numbers attached to drug use stored on mobile phones therapists recommend they are deleted.
  • Give spouse car keys and bank card
  • Remove alcohol from house
  • Remove drug paraphernalia from the home

Programme Participants will find implementing some of these strategies throughout their day early recovery will reduce thoughts of using alcohol and drugs. Through time thoughts will decrease if the Aftercare plan is followed and the participant continues to work on their own recovery.

Frequently Asked Questions

“I don’t have the time to commit to all of these suggestions will I relapse?”

No. The list of recommendations to stay sober may appear overwhelming. Most people in recovery will not follow the full list. They will find a routine that works for them. Including self-care, phoning a friend in recovery once per day and if possible attending a recovery meeting such an AA, NA or CA.

On the scales of balance, a short time spent staying sober each day is worthwhile to maintain recovery.

“What is a recovery sponsor?”

A recovery sponsor can be found in 12 Step fellowship meetings such as AA, NA or CA the therapists at Abbeycare will explain their role in greater depth.

The sponsor will guide sponsees through the 12 Step Programme which has been created as a self-help programme to maintain recovery from alcohol and drugs. And help participants live a happy, purposeful life.

“How do you work the 12 Steps into your life?”

The 12 Step article found on Abbeycare’s web page will highlight in detail the basis of the 12 Steps and how beneficial they can be for people in recovery.

The main principle is abstinence from alcohol and drugs. If abstinent the intense craving for more alcohol and drugs will not occur.

The 12 Steps are supportive and provide the tools for living a sober lifestyle.

“Should I take an any of the tablets to stop craving alcohol when I leave rehab?”

Alcohol or Opiate blockers are common tablets for those who are not accessing support or therapy for their addiction.

At Abbeycare through Detox, Rehab and Aftercare the client is supported for upwards of 18 months and in this time are shown many beneficial techniques for staying sober.

Abbeycare helps clients build an ongoing support network Post Rehab and the tools to combat thoughts of using alcohol and/or drugs.

“If I leave rehab early can I come back?”

Most programmes within Abbeycare last 28 Days (see Long Term Rehab Article) an intensive therapeutic programme is created to promote the change required to get sober and stay sober.

Leaving rehab early and coming back is in-practical participants are encouraged to complete the 28 Days consecutively.

How is outpatient detox different from inpatient?

Outpatient detox is done from home, while inpatient is done from a rehab facility. Most public outpatient programs, are facilitated by NHS Drop-in clinics. The drop-in clinic is a form of community-based treatment option which any UK citizen can access for free.

Outpatient clinics by the NHS mean:

  • The individual can live at home and continue with normal activities whilst recovering from drug addiction.
  • Methadone or buprenorphine treatment as a primary means of treating prescription medicine addiction
  • Having a keyworker to monitor progress
  • Training in naloxone administration (in case of overdose)
  • Training in the safe use/procurement/disposal of injecting equipment
  • Completion of drug use/treatment diaries
  • Urine and oral fluid samples for monitoring progress

 Choosing a private inpatient rehab means a client stays at a clinic with a structured programme in place. The duration of the stay is 28 days, on average. The goal is to have a predictable, controlled environment where a client is supported by experts in addiction rehab.

The NHS does provide public inpatient rehab, but the long waiting times can deter individuals from enquiring about the process. For ease of admissions and high quality care, dial Abbeycare direct.

Final Thoughts...

Relapse Prevention may be under-rated by some as the belief that removing the dependence on the drug of choice will open the door to freedom.

If new to recovery clients will learn drugs and alcohol are just a symptom to the underlying human condition. There is more to recovery than the cessation of their drug of choice.

Thinking and behaviour patterns are required to be reviewed and re-learned as the participant learns how to live again without turning to substances to deal with feelings or the stress of life.

After completing Detox and Rehab within Abbeycare encouragement to attend the Aftercare programme is given as the early days after rehab when participants return home can be the most challenging.

Participants are encouraged to continue talking about their feelings, access recovery meetings, find a sponsor and change old behaviour patterns associated with the purchasing and using of alcohol and drugs.

If you visualise yourself free from alcohol and drugs living a happy and productive life?

And wish to learn more about our Addiction Treatment or Aftercare Programme call our free 24/7 Helpline on 01603 513 091 or fill out the form below to speak to a trained addiction counsellor.

Abbeycare Pricing Bot

Last Updated: February 20, 2022

About the author

Peter Szczepanski

Peter has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. Peter also co-authored the new 6th edition of Drugs In Use by Linda Dodds, writing Chapter 15 on Alcohol Related Liver Disease. Find Peter on Respiratory Academy, Aston University graduates, University of Birmingham, Q, Pharmaceutical Journal, the Dudley Pharmaceutical Committee, Dudley Council, Twitter, and LinkedIn.